TO THE EDITOR: A resident at our university clinic recently evaluated a patient who reported using lithium orotate, 240 mg/d, for self-diagnosed bipolar disorder (BD) (diagnosis was not confirmed, the patient did not show signs of toxicity). Lithium orotate is a salt of orotic acid and lithium. It is widely available over the Internet (eg, Amazon.com) and marketed as a dietary supplement for conditions such as BD, alcoholism, and aggression, although it is not FDA-approved for any indication. Lithium orotate is available in some drug stores and health food stores under various brand names (eg, “Doctor’s Best Lithium Orotate”).

There are no studies evaluating the efficacy or safety of lithium orotate for BD. One small study1 suggested this preparation may be useful for alcoholism. However, Smith and Schou2 reported that “glomerular filtration rate and urine flow were markedly lower in rats given lithium orotate than in rats given lithium carbonate, sodium chloride, or a sham injection. The renal lithium clearance was significantly lower, the kidney weight and the lithium concentrations in serum, kidney and heart significantly higher after injection of lithium orotate than after injection of lithium carbonate.” The authors felt that clinical use of lithium orotate was not warranted. One case of mild acute lithium orotate toxicity3 has been reported. An 18-year-old woman intentionally ingested 18 tablets of a dietary supplement containing lithium (120 mg of lithium orotate per pill containing 3.83 mg of elemental lithium per 100 mg of organic lithium orotate compared with 18.8 mg of element lithium per 100 mg of inorganic lithium carbonate).3 Obviously, this preparation can be seriously toxic in higher than intended or accidental overdose.

Similar to other “dietary supplements,” the distribution and use of lithium orotate is unregulated. Patients may not be aware of possible toxicity and unknown, yet assumed, long-term health risks of using lithium orotate on their own, without proper monitoring of thyroid and kidney functions. Physicians may not be aware that patients are using lithium orotate, unless informed by their patients or unless they actively query about specific “nutritional supplements.” A ban of this preparation seems unachievable at the present time. Therefore, it seems that we need to educate ourselves and our patients about the inappropriateness of self-medicating with lithium orotate, its possible toxicity in acute overdose, and health risks of long-term use. ν

DISCLOSURE: Dr. Balon reports no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.